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Living with Chronic Pain

PUP 2224

Delyth Meirion- Owen

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Session Learning Outcomes• To gain an understanding of chronic

pain (CP)

• To identify how CP can impact upon the life of an individual

• To identify examples of local and national support available .

• To discuss the role of the nurse in relation to self care and independence .

• To explore the potential challenges to the role and effective management.

• General overview of chronic pain.

• https://www.youtube.com/watch?v=4b8oB757DKc&feature=player_embedded

• (5 MINs)

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overview• Pain is defined as an unpleasant sensory and emotional experience

associated with actual or potential tissue damage.

• Chronic pain is pain that persists over a period of time, typically for at least three months.

• A recent estimate reports 7.8 million people in the UK suffer moderate to severe pain that has lasted for more than six months.

• Studies suggest that it is more commonly reported by women and those from socially or financially disadvantaged groups.

(Donaldson 2009)

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Possible causes of chronic pain.

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Pain classification Pain is classified according to duration

• Acute Pain –sudden onset , continues until healing begins. May be intense , intolerable. Associated with medical condition or injury.

• Response area in the brain initiates an autonomic response .

• The thalamus, hypothalamus & reticular formation promote diaphoresis ,tachycardia, hypertension & tachypnoea in response to pain.

• Chronic pain- pain continues even after healing is complete. May be intense , little or no autonomic response .

• Pain exists after injury or disease has ceased. Often considered as a syndrome ‘ a medical condition in its own right’. (Melzack & Wall 1988)

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What is the impact of chronic pain?

Chronic PainInactive/overactive

Fatigue /lack of stamina

Weak muscles and loss of fitnessMedication.

Weight Gain Stress ,anxiety, tension

Sleep Difficulties.Anger ,Fear ,Frustration

Low mood/negative thinking Time off work , Family & Money

Worries

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Pain AssessmentWhy? To select the most appropriate pharmacological & non pharmacological interventions. Every

pain assessment must include the following information;

• Location of pain-

• Duration of pain-

• Onset- Frequency –

• Aggregating factors-

• Relieving factors-

• Sleep patterns-

• What additional questions could the nurse ask ?

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The McGill Pain Questionnaire .(Melzack 1975)

Four Dimensions of the Pain Experience. Adapted from Manias et al. 2002

925/05/2015

Psychological

physiological

Emotional

Social

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Pain Assessment Psychological and emotional response to pain?

• The patient’s expectations of any potential treatments

• The patient’s concerns of the cause of their pain

• Any personal or spiritual beliefs

• Acceptable pain levels

• Pain levels that will allow the patient back to work

• Feelings of stress and Anxiety

• Any coping mechanisms

• The patient’s preference regarding any treatment options. (MacLellan ,2006)

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The nurses Role in supporting clients with chronic pain living in the community.

• Patient Education

• Lifestyle Adjustments

• Access to social Supports

• Empower patients to access psychosocial support. (Wright 2015)

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Community or practice Nurse Involvement

• Optimizing the control of chronic pain

• Pain diary evaluation- to monitor effectiveness of analgesia.

• Education re treatment compliance

• Monitoring for side effects

• Pain Intensity measurement – (number rating scale 0-10. Aim 0-4. 4 representing mild discomfort .)

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Nurses role in patient education• Encourage patient to keep a pain

diary .

• To monitor effectiveness of analgesia.

• To monitor effectiveness of other pain management interventions.

• Early identification of problems

• Problem solving .

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Role of the nurse –in non malignant pain

• Liaise with primary care (GP) & secondary care (Hospital, MDT) - maintain and improve communication.

• Teaching patient- pain self assessment.

• Pain Diary- monitor effectiveness – complementary therapies, i.e. acupuncture, biofeedback, relaxation techniques .

• Devise an action plan in the event of sudden onset of severe pain. Access to emergency services. ( Wright 2015)

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What support is available for people with pain?

• Pain clinics -For assessment and possible pain management, gain with advice on living a fuller life in spite of pain. Sometimes a Consultant with an interest in pain will prescribe drugs or give injections to try to control pain. Other clinics have teams of doctors, psychologists, nurses, physiotherapists, occupational therapists.

• Pain Management Service The Walton Centre for Neurology and Neurosurgery NHS Foundation Trust

• Chronic Pain Clinic Warrington and Halton Hospitals NHS Foundation Trust• Chronic pain Royal Liverpool and Broadgreen University Hospitals NHS Trust

• chronic pain MDT Royal Liverpool and Broadgreen University Hospitals NHS Trust

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Support for people with Chronic Pain• Pain Management Programmes (PMP)

• A psychologically-based rehabilitative treatment for people with chronic pain • It is delivered in a group setting by an interdisciplinary team of experienced health care

professionals working closely with patients.

• Some Pain Centres may run Pain Management Programmes that aim to teach a group of patients with similar problems about pain, how best to cope with it and how to live a more active life, others may offer acupuncture and other complementary therapies.

• The aim of the PMP is to reduce the disability and distress caused by chronic pain by teaching physical, psychological and practical techniques to improve quality of life. It differs from other treatments provided in Pain Clinics in that pain relief is not the primary goal, although improvements in pain following participation in a Pain Management Programme have been demonstrated.

• Referral to a Pain Management Programme is usually via the local pain clinic.

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Pain Management Programmes • Pain management strategies may be behavioural, cognitive ,

physical, pharmacological or other .• Behavioural-contingency management , graded exercise,

relaxation, progressive muscle relaxation.• Cognitive- Imagery, Meditation and Prayer, Information, stress

management.• Physical – Surgical, TENS, Acupuncture, massage, reflexology. • Pharmacological-non opioid analgesics (paracetamol), opioid

analgesics ( morphine) , direct action drugs( sedatives, anti depressants.

• Other- Hypnosis, support groups, internet , self help groups, alternative therapies. Marks et al (2015)

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‘Self Management for life’ • The programme has seven weekly sessions, lasting 3 hours each. • The aims of the programme• Develop skills and techniques to cope with daily challenges

• Gain practical solutions for day-to-day issues

• Set health goals to improve an individuals wellbeing and quality of life

• Develop and implement an action plan

• Provide more information about the condition , to enable people to make informed choices.

• To Liaise between the GP and healthcare team on an individual plan for condition management.

• To increase confidence within the patient and encourage them to play a key role in management of their health.

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The Expert Patients Programme• The EPP is a course

designed for adults living with any long-term health condition.

• The EPP aims to help people take control of their health will by learning new skills in order to manage their condition on a daily basis.

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What are the challenges in self care management?• Individual tolerance of pain

• Treatment compliance

• Assessment is not a simple process

• Pain Questionnaires , commonly use descriptive words, ( meaning, culture, ethnicity?)

• Assessment tools are not sensitive to age, disability or culture.

• Reliance upon reports of significant others.

• Pain is often under treated – inadequate assessment?

• Focus on underlying physical problems.

• Negative Stereotypes

• Addiction fears

• Inappropriate use of non pharmacological interventions.

• Professional perception of acceptable pain behaviour and treatment.

• Communication problems.

• Working with vulnerable clients

• Symptom Identification e.g. HIV.

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Useful Resources.

• The British Pain Society ( useful addresses) https://www.britishpainsociety.org/useful-addresses/

• Chronic Pain, A self Help Guide. http://www.moodjuice.scot.nhs.uk/chronicpain.asp

• Self Management UK. http://selfmanagementuk.org/

• NHS Choices. Live Well. http://www.nhs.uk/Livewell/Pain/Pages/Sexadviceforpainsufferers.aspx

• Pain Tool Kit – 2009. http://www.paintoolkit.org/downloads/Pain_Toolkit_patient_booklet_copy_Short_Versions.pdf

• Pain Management programme . http://www.thewaltoncentre.nhs.uk/112/pain-management-programme-pmp.html

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Useful Resources• Health Survey for England (2011).

http://www.hscic.gov.uk/catalogue/PUB09300/HSE2011-Ch9-Chronic-Pain.pdf

• Merskey H, Bogduk N (eds).(1994)Classification of Chronic Pain. International Association for the Study of Pain, Seattle,. Part III, Pain Terminology, updated in 2011.www.iasp-pain.org/Content/NaviationMenu/Publications/Freebooks/default/htm

• Donaldson L. (2009) Pain: Breaking through the barrier. Chapter in 150 years of the Annual Report of the ChiefMedical Officer: On the state of public health 2008. DH, London.

www.dh.gov.uk/en/Publicationsandstatistics/Publications/AnnualReports/DH_096206

MarksF, Murray,M, Evans,B. Estacio, E,V. (2015) Health Psychology , Theory ,Research and Practice. Lonson. Sage.

Wright ,S. (2015) Pain management in Nursing Practice. Los Angeles. Sage.